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Alabama/Georgia Rural Health Clinic
Conference
Presented by Cahaba Government Benefit Administrators®, LLC
Provider Outreach and Education
June 4, 2013
Disclaimer
O This resource is not a legal document. This
presentation was prepared as a tool to assist our
providers. This presentation was current at the time it
was created.
O Although every reasonable effort has been made to
assure accurate information, responsibility for correct
claims submission lies with the provider of services.
Reproduction of this material for profit is prohibited.
DDE User Sharing/Reassigning IDs
O User’s ID and password serve as an electronic
signature, and should not be shared
O Complete the Part A System Access Application at:
http://www.cahabagba.com/part-
a/claims/electronic-data-interchange-edi/forms/ to
add or deactivate a user
O Violations will result in immediate deactivation
O Call EDI Helpdesk with questions:
(866) 582-3253
Connectivity Vendor
O Effective July 1, 2013, Cahaba GBA will no longer
support dial-up connections
O All electronic transactions should be routed through a
Cahaba GBA approved Network Service Vendor (NSV) https://apps.cahabagba.com/providerLookups.vendorB.do
O Current user ID and password can be used
O Direct questions to the Cahaba GBA EDI helpdesk
EDI Update
O Dial-up users may experience busy signals due to
reduced capacity
O Direct submitters are encouraged to begin using a
Network Service Vendor as soon as possible
O A list of approved NSVs is available on our website at http://www.cahabagba.com/part-a/claims/electronic-data-
interchange-edi/edi-connectivity-vendors/
O Contact the EDI Helpdesk for assistance at:
(866)-582-3253
Claim Adjustments
O Cahaba will adjust claims with “through dates” on or
after April 1, 2013, that processed between April 1
and April 14, 2013, with the following criteria:
O Value Code 73
O A deductible applied (A1, B1 or C1 Value Code) and
O Negative reimbursement (at the line level for outpatient
claims or negative reimbursement at the claim level for
inpatient claims)
O All adjustments for previously held claims will be
completed by June 30th
Revalidation Reminder
O All providers enrolled with Medicare prior to March 25, 2011, must revalidate
O Cahaba will send notices until March 23, 2015
O Complete and submit enrollment forms within 60 days
O PECOS is the preferred and easiest method to revalidate
O Do not submit an enrollment form until you receive a request to revalidate
Electronic Funds Transfer
O EFT enrollment is required
at the time of:
O Initial enrollment
O Revalidation
O Enrollment changes
O Complete the CMS-588
form:
O Must contain original
signature of the
authorized/delegated
official
O Include voided check
http://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/downloads/CMS588.pdf
Redetermination Smart Form -
Reminder O Complete all required fields
(highlighted in red)
O Complete the form
electronically
O Answer all questions in
section 16
O Print, sign and fax
Smart Form Errors
O Incomplete or inaccurate original Document Claim
Number (DCN)
O Incorrect date format submitted on the form
O Correct date format is MM/DD/YYYY
O Mailing Smart forms instead of faxing
O Submit Smart form via dedicated fax number
O If mailing, complete CMS-20027
O Cover sheets should not be submitted
ForeSee
O Rate your Cahaba
GBA experience O Quality of information
O Freshness of content
O Clarity of organization
O Location of
information
O Consistency of speed
O Overall satisfaction
11
We need to hear from you!
Clinical Education
O Comprehensive Error Rate Testing
O CERT Data Analysis
O CMS Signature Requirements
O CMS Resources
Comprehensive Error Rate Testing (CERT)
•Medicare Trust Fund
Protect
•Correct Claim Process/Payment
Measure
•Contractor and Provider
Assess
Evaluate
13
Part A CERT Feedback: 2013 Rural
Health
Clinics
Insufficient
Documentation
Disagree per SSA
1862(a)(1)(A)
IOM Pub 100-4,
Chapter 9, § 20
Method of Medicare
Payment for RHC and
FQHC Services
PUB 100-08, Chapter 3,
§ 3.3.2.4 - Signature
Requirements
Missing:
Submitted rural health clinic
visit note missing signature
of rendering provider.
Note is typed with typed
initials only.
Missing legible, signed and
dated clinic note. Initially
received clinic note with
questionable date unrelated
to this claim.
Lacks MD signature on clinic
note.
Change Request 6698:
O Signature Requirements for Medical Review Purposes
O Medicare requires that services provided/ordered be
authenticated by the author
• Hand written or
• Electronic signature
O Stamp signatures are not acceptable
CMS Signature Requirements
Rural Health Clinics (RHCs)
CMS Publication 100-07 - The State Operations Manual
Appendix G – Guidance to Surveyors: Rural Health Clinics
(RHCs) §491.8 Condition of Coverage: Staffing and Staff
Responsibilities
1 - Physician Responsibilities
O Ascertain through written documentation, such as dates
and signatures, that the physician staff member
satisfactorily meets the requirement of periodically
reviewing the clinic’s patient records, provides medical
orders, and provides medical care services to the patients.
Medical Record Documentation
MLN Matters® Number: SE1237
Importance of Preparing/Maintaining Legible Medical Records
O General Principles of Medical Record Documentation
Medical records should be complete and legible; and
Medical records should include the legible identity of the
provider and the date of service
O Amendments, Corrections and Delayed Entries in Medical Documentation
Documents containing amendments, corrections, or delayed
entries must employ acceptable recordkeeping principles
O Medicare Signature Requirements
For medical review purposes, Medicare requires that services
provided/ordered be authenticated by the author. The method
used shall be a handwritten or electronic signature
17
Questions
Provider Contact Center
Alabama, Georgia and Tennessee Providers: 1-877-567-7271
